Atropine Eye Drops Research Articles

Sublingual use of atropine eye drops for the treatment of clozapine induced sialorrhea

ABSTRACT Clozapine is the drug of choice for patients with treatment-resistant schizophrenia. However, it has a variety of adverse effects. Sialorrhea is a bothersome side effect that can have an impact on both medical and psychosocial aspects. There is limited literature on the use of 1% atropine eye drops sublingually for the treatment of clozapine-induced sialorrhea (CIS). In this case series, we report three patients of CIS treated successfully with 1% atropine eye drops given sublingually.

Efficacy and Safety of Different Atropine Regimens for the Treatment of Myopia in Children

Additional data are required regarding atropine treatment regimens for control of myopia progression. To investigate the efficacy and safety of different atropine regimens for myopia in children. This was a secondary analysis of the 3-year results of the 24-Month Myopia Outcome Study of Atropine in Children (MOSAIC) trial, called the MOSAIC2 trial. The MOSAIC trial was an investigator-led, double-masked, randomized clinical trial of different atropine concentrations and regimens. The MOSAIC2 study took place at the Centre for Eye Research Ireland, in Dublin, Ireland, and included children and adolescents with myopia from the MOSAIC trial. Data analysis was conducted from November 2023 to February 2024. Participants were randomly assigned to the following cohorts: group 1, nightly placebo for 2 years then 0.05% atropine eye drops for 1 year and group 2, nightly 0.01% atropine eye drops for 2 years then rerandomization to placebo nightly, tapering placebo, or tapering of 0.01% atropine eye drops for 1 year. Observed changes in cycloplegic spherical equivalent refraction and axial length from month 24, or baseline, to month 36. A total of 199 children with myopia (mean [SD] age, 13.9 [2.4] years; 121 female [60.8%]) of the 250 children and adolescents from the MOSAIC trial were included in the MOSAIC2 trial analysis. Of 83 participants assigned to group 1, 66 (79.5%) reconsented to year 3, and 61 (73.5%) completed the trial. Of 167 participants assigned to group 2, 133 (79.6%) continued to year 3, and 121 (72.5%) completed the trial (0.01% atropine, then nightly placebo: n = 31 and n = 29 [93.5%]; 0.01% atropine, then tapering placebo: n = 29 and n = 25 [86.2%]; 0.01% atropine then tapering 0.01% atropine: n = 73 and n = 67 [91.8%], respectively). Compared with the group taking placebo then 0.05% atropine, the combined atropine then placebo groups had more spherical equivalent progression (adjusted difference, -0.13 diopters [D]; 95% CI, -0.22 to -0.04 D; P = .01) and axial elongation (adjusted difference, 0.06 mm; 95% CI, 0.02-0.09 mm; P = .008), and the group taking 0.01% atropine then tapering 0.01% atropine had more axial elongation (adjusted difference, 0.04 mm; 95% CI, 0.009-0.07 mm; P = .04). In the group taking placebo then 0.05% atropine, 15% (n = 10) and 8% (n = 5) reported blurred near vision and photophobia, respectively, during year 3, compared with 3% (n = 2) and 0%, respectively, in the group taking 0.01% atropine then tapering 0.01% atropine, and no reports in both placebo groups. Despite more adverse events, participants using 0.05% atropine during year 3 had no differences in treatment completion rates and exhibited 0.13-D less myopia progression and 0.06-mm less axial elongation, compared with participants using placebo, supporting consideration of treatment as given to the group taking 0.05% atropine in this European population. isrctn.org Identifier: ISRCTN36732601.

Controversies in Myopia Control Treatment: What Does it Mean for Future Research?

Treatment of myopia has been informed by more than 3 decades of clinical trials and other observations. However, controversies regarding myopia control remain, such as when to stop treatment and what is the long-term efficacy of treatment. This perspective aims to describe clinically relevant and current controversies regarding myopia treatment. Perspective. We reviewed clinical trial data and other studies regarding myopia control therapies. Controversies in myopia treatment are related to the efficacy of low dose atropine eyedrops and new lens design spectacles to substantially reduce progression of myopia. In addition to efficacy, safety of therapies including soft contact lenses, orthokeratology and low-level red light remains a concern. The therapeutic role of outdoor time in reducing myopia progression also requires further investigation. More research is necessary to confirm treatment effectiveness, duration of required treatment, tapering schedules and when to begin and stop treatment. Myopia management is evolving and maintaining competency in the multiple approaches poses a challenge. Key challenges include identifying high-risk children who would benefit most from treatment, limited evidence supporting the effectiveness of myopia progression control treatments in certain populations, and concerns regarding availability and cost of treatment, which may create socioeconomic barriers to access. The limitations of current methods to slow or stop myopia progression highlight the need for continuing rigorous investigation of new and improved strategies to reduce the burden of myopia.

Myopi‐X spectacle lenses vs atropine 0.01% for myopia control: Turkish study

Abstract: The global surge in myopia poses significant health and economic challenges due to associated complications. Current myopia management strategies include atropine eye drops, orthokeratology, special design contact lenses, and myopia‐control spectacle lenses. The Miyopi‐X (Novax®) spectacle lens is a novel peripheral defocus progressive addition lens designed to mitigate myopia progression. This study aims to assess the efficacy of Miyopi‐X spectacle lenses compared to single vision lenses (SV) and atropine 0.01% eye drops in myopia management.Methods: A retrospective study was conducted on patients aged 5–18 years. Clinical records of patients using Myopi‐X lenses, SV lenses, and those receiving atropine 0.01% eye drop treatment between September 1, 2022, and September 30, 2023, were reviewed. Primary outcome measures included cycloplegic spherical equivalent refraction (SE) and axial length (AL) measured at baseline and 12 months.Results: The study included 92 patients: 41 in the Myopi‐X group, 25 in the SV group, and 26 in the atropine group. At 12 months, both Myopi‐X and atropine 0.01% groups exhibited significantly less SE progression than SV lenses (p < 0.001). No significant difference in SE change was observed between Myopi‐X and atropine 0.01% (p: 0.90). Similarly, both Myopi‐X and atropine 0.01% groups showed significantly less AL progression than SV lenses at 12 months (p < 0.001). However, pairwise comparisons revealed a significant difference in AL change between Myopi‐X and atropine 0.01% groups (p: 0.02), with atropine 0.01% demonstrating better control over axial elongation compared to Myopi‐X lenses.Conclusions: Miyopi‐X lenses and atropine 0.01% are effective in slowing myopic axial elongation. This study represents the first of its kind conducted on Turkish myopic children/adolescents.References Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, et al. Low‐Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double‐Blinded, Placebo‐Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126:113‐124. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123:1036‐42.

Role of caffeine in slowing progression of myopia: 1-year results from a prospective, longitudinal clinical trial.

To determine the role of topical caffeine in slowing progression of myopia, both as a standalone treatment and in combination with atropine. In a prospective, randomized, dispensing clinical trial, 96 children with myopia, aged 6-13 years, spherical equivalent (SE) from -0.50 diopters (D) to -6.00 D and astigmatism less than 2.00 D were randomly assigned to nightly use of either 2 % caffeine, 0.02 % atropine with 2 % caffeine (combination) or 0.02 % atropine eye drops. An additional 86 children with myopia were enrolled in a concurrent parallel group to wear single-vision (SV) spectacles. The primary outcomes were changes in SE and axial length (AL) over a period of 12 months for each group. All groups progressed in myopia. At 12 months, the mean change in SE/AL was -0.76 ± 0.51 D / 0.37 ± 0.20 mm and -0.70 ± 0.55 D / 0.35 ± 0.23 mm with SV and 2 % caffeine, respectively. In comparison, progression was slower at -0.46 ± 0.50 D / 0.24 ± 0.19 mm and -0.47 ± 0.38 D / 0.23 ± 0.18 mm with atropine monotherapy and combination groups, respectively. Compared to the change in AL with SV, the change in AL was significantly less with 0.02 % atropine and the combination group (post hoc analysis, P = 0.024 and 0.007, respectively). Similarly, the change in SE was significantly less with 0.02 % atropine compared to the SV group (P = 0.027). Used as a standalone treatment, topical 2 % caffeine did not slow myopia progression. When combined with atropine, caffeine had no impact on the efficacy of atropine in slowing myopia.

Myopi‐X spectacle lenses vs atropine 0.01% for myopia control: Turkish study

Abstract: The global surge in myopia poses significant health and economic challenges due to associated complications. Current myopia management strategies include atropine eye drops, orthokeratology, special design contact lenses, and myopia‐control spectacle lenses. The Miyopi‐X (Novax®) spectacle lens is a novel peripheral defocus progressive addition lens designed to mitigate myopia progression. This study aims to assess the efficacy of Miyopi‐X spectacle lenses compared to single vision lenses (SV) and atropine 0.01% eye drops in myopia management.Methods: A retrospective study was conducted on patients aged 5–18 years. Clinical records of patients using Myopi‐X lenses, SV lenses, and those receiving atropine 0.01% eye drop treatment between September 1, 2022, and September 30, 2023, were reviewed. Primary outcome measures included cycloplegic spherical equivalent refraction (SE) and axial length (AL) measured at baseline and 12 months.Results: The study included 92 patients: 41 in the Myopi‐X group, 25 in the SV group, and 26 in the atropine group. At 12 months, both Myopi‐X and atropine 0.01% groups exhibited significantly less SE progression than SV lenses (p < 0.001). No significant difference in SE change was observed between Myopi‐X and atropine 0.01% (p: 0.90). Similarly, both Myopi‐X and atropine 0.01% groups showed significantly less AL progression than SV lenses at 12 months (p < 0.001). However, pairwise comparisons revealed a significant difference in AL change between Myopi‐X and atropine 0.01% groups (p: 0.02), with atropine 0.01% demonstrating better control over axial elongation compared to Myopi‐X lenses.Conclusions: Miyopi‐X lenses and atropine 0.01% are effective in slowing myopic axial elongation. This study represents the first of its kind conducted on Turkish myopic children/adolescents.References Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, et al. Low‐Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double‐Blinded, Placebo‐Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126:113‐124. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123:1036‐42.

Choroidal thickness in myopic children: one‐year follow‐up study with 0.01% atropine eye drops

Choroidal thickness in myopic children: one‐year follow‐up study with 0.01% atropine eye drops

Vision‐related quality of life of myopic children using combination treatment: Atropine and defocus‐incorporated multiple segment spectacle lenses

Purpose: To assess vision‐related quality of life (VR‐QoL) in children undergoing myopia control treatment with atropine compared to children treated with combination treatment of atropine and Defocus incorporated multiple segments (DIMS) spectacle lenses.Methods: Longitudinal study that included myopic children aged 4 to 16 years undergoing myopia control treatment. Group A included children on 0.025% atropine eyedrops and single‐vision lenses, and group B included children on combined treatment of 0.025% atropine and DIMS lenses. Demographic and clinical data, including cycloplegic spherical equivalent refraction (SER) and axial length (AL), were noted. VR‐QoL was assessed using the Children's Visual Function questionnaire (CVFQ) and the Pediatric Eye Questionnaire (PedEyeQ) before initiating and after 6 months of treatment. Statistical analyses (Mann‐Whitney U‐test or t‐test) were performed.Results: 95 patients were included: 50 children in group A, mean age 8.94 ±2.50 years and 45 children in group B, mean age 9.51 ±2.46 years (p = 0.266). No significant differences were found in the overall VR‐QoL between both groups with PedEyeQ. Functional Vision and Social item scores (PedEyeQ) significantly improved at the 6M follow‐up in group A (p = 0.03 and p = 0.016, respectively) and group B (all p = 0.01). Scores on the Eye Condition item (PedEyeQ) at baseline and at 6M follow‐up were reversed; a decrease in group A, 89.73 [69.86‐89.73] and 64.98 [50.02‐74.99] (p < 0.01), and an increase in group B, 69.96 [69.96‐89.72] and 74.97 [43.62‐85] (p = 0.039). For the CVFQ, only Group B showed an improvement in General Vision (p = 0.049) and Competence (p = 0.031) scores.Conclusions: Myopic children treated with atropine and those using combination treatment (atropine and DIMS) do not seem to have significant differences in overall VR‐QoL following 6 months of treatment. General Vision (CVFQ), Competence (CVFQ) and Eye Condition (PedEyeQ) scores improve significantly for children on combination treatment.

Vision‐related quality of life of myopic children using combination treatment: Atropine and defocus‐incorporated multiple segment spectacle lenses

Purpose: To assess vision‐related quality of life (VR‐QoL) in children undergoing myopia control treatment with atropine compared to children treated with combination treatment of atropine and Defocus incorporated multiple segments (DIMS) spectacle lenses.Methods: Longitudinal study that included myopic children aged 4 to 16 years undergoing myopia control treatment. Group A included children on 0.025% atropine eyedrops and single‐vision lenses, and group B included children on combined treatment of 0.025% atropine and DIMS lenses. Demographic and clinical data, including cycloplegic spherical equivalent refraction (SER) and axial length (AL), were noted. VR‐QoL was assessed using the Children's Visual Function questionnaire (CVFQ) and the Pediatric Eye Questionnaire (PedEyeQ) before initiating and after 6 months of treatment. Statistical analyses (Mann‐Whitney U‐test or t‐test) were performed.Results: 95 patients were included: 50 children in group A, mean age 8.94 ±2.50 years and 45 children in group B, mean age 9.51 ±2.46 years (p = 0.266). No significant differences were found in the overall VR‐QoL between both groups with PedEyeQ. Functional Vision and Social item scores (PedEyeQ) significantly improved at the 6M follow‐up in group A (p = 0.03 and p = 0.016, respectively) and group B (all p = 0.01). Scores on the Eye Condition item (PedEyeQ) at baseline and at 6M follow‐up were reversed; a decrease in group A, 89.73 [69.86‐89.73] and 64.98 [50.02‐74.99] (p < 0.01), and an increase in group B, 69.96 [69.96‐89.72] and 74.97 [43.62‐85] (p = 0.039). For the CVFQ, only Group B showed an improvement in General Vision (p = 0.049) and Competence (p = 0.031) scores.Conclusions: Myopic children treated with atropine and those using combination treatment (atropine and DIMS) do not seem to have significant differences in overall VR‐QoL following 6 months of treatment. General Vision (CVFQ), Competence (CVFQ) and Eye Condition (PedEyeQ) scores improve significantly for children on combination treatment.

Two‐year changes of macular choroidal thickness in response to 0.01% atropine eye drops: Results from the myopia outcome study of atropine in children (MOSAIC) clinical trial

AbstractPurposeTo investigate 2‐year changes in macular choroidal thickness (ChT) in children receiving 0.01% atropine eyedrops and its relationship with spherical equivalent refraction (SER) progression and axial length (AL) elongation.MethodsA total of 250 myopic children aged 6–16 years (167%–0.01% atropine, 83‐placebo) were enrolled in the MOSAIC (ISRCTN36732601) clinical trial. Participants with complete 2‐year ChT (Topcon Triton Swept‐Source OCT), SER, and AL data were included in this study. Changes in macular ChT at 2 years and associations with changes in SER and AL elongation were analysed using linear mixed models.ResultsA total of 187 children (126%–0.01% atropine, 61‐placebo) were included in the analysis. Choroidal thickness over 2 years was stable in the 0.01% atropine compared with placebo group, which exhibited consistent thinning in subfoveal (mean ± SE: 0.49 ± 2.22 μm vs. −9.46 ± 2.69 μm; p = 0.034), parafoveal (1.40 ± 1.73 μm vs. −8.11 ± 2.08 μm; p = 0.002), and perifoveal (0.80 ± 1.25 vs. −6.17 ± 1.69; p = 0.002) macular subfields. Choroidal thickening was observed in participants with slower axial eye growth and myopia progression, regardless of their treatment group. Mediation analysis indicated that atropine 0.01% had a significant effect on ChT, with 68.3% of the effect being direct and 31.7% mediated through axial length changes. For SER, the direct effect on ChT was 80%, with the remaining 20% mediated by SER changes.ConclusionsMyopic participants treated with 0.01% atropine exhibited stable ChT over 2 years, whereas the placebo group showed consistent thinning. The effect of atropine 0.01% on ChT was only partially explained by axial length and SER changes, indicating a direct effect of atropine treatment on the choroid.

The Potential of SHAP and Machine Learning for Personalized Explanations of Influencing Factors in Myopic Treatment for Children.

Background and Objectives: The rising prevalence of myopia is a significant global health concern. Atropine eye drops are commonly used to slow myopia progression in children, but their long-term use raises concern about intraocular pressure (IOP). This study uses SHapley Additive exPlanations (SHAP) to improve the interpretability of machine learning (ML) model predicting end IOP, offering clinicians explainable insights for personalized patient management. Materials and Methods: This retrospective study analyzed data from 1191 individual eyes of 639 boys and 552 girls with myopia treated with atropine. The average age of the whole group was 10.6 ± 2.5 years old. The refractive error of spherical equivalent (SE) in myopia degree was base SE at 2.63D and end SE at 3.12D. Data were collected from clinical records, including demographic information, IOP measurements, and atropine treatment details. The patients were divided into two subgroups based on a baseline IOP of 14 mmHg. ML models, including Lasso, CART, XGB, and RF, were developed to predict the end IOP value. Then, the best-performing model was further interpreted using SHAP values. The SHAP module created a personalized and dynamic graphic to illustrate how various factors (e.g., age, sex, cumulative duration, and dosage of atropine treatment) affect the end IOP. Results: RF showed the best performance, with superior error metrics in both subgroups. The interpretation of RF with SHAP revealed that age and the recruitment duration of atropine consistently influenced IOP across subgroups, while other variables had varying effects. SHAP values also offer insights, helping clinicians understand how different factors contribute to predicted IOP value in individual children. Conclusions: SHAP provides an alternative approach to understand the factors affecting IOP in children with myopia treated with atropine. Its enhanced interpretability helps clinicians make informed decisions, improving the safety and efficacy of myopia management. This study demonstrates the potential of combining SHAP with ML models for personalized care in ophthalmology.

Kongenitale Katarakt und Pseudophakie – Myopiekontrolle in einer ungewöhnlichen Ausgangssituation

Purpose. An effective reduction in the progression of myopia can be achieved by pharmacological administration of low-dose atropine eye drops, the fitting of multifocal and Ortho-K contact lenses or with specialized spectacle lenses. The case report describes the successful stabilization of myopia and visual acuity in a 14-year-old patient who had a posterior chamber IOL implanted at the age of 2 as a result of a congenital cataract. Material and Methods. A 14-year-old untreated patient with pseudophakia after congenital cataract, was fitted with multifocal rigid-gas permeable (RGP) contact lenses for high myopia, irregular astigmatism, anisometropia and nystagmus to increase visual acuity and prevent myopia progression. Results. With the fitted contact lenses, good lenses tolerance was achieved with a daily wearing time of 12 hours and an increase of visual acuity from spectacle-corrected visual acuity (20/160) to contact lens-corrected visual acuity (20/40) and stabilization of myopia over 3.5 years. With the contact lenses in combination with progressive spectacles, it was possible to achieve an additional increase in near vision and successful treatment of the patient. With her new quality of life, the patient can now complete school education independently and start an apprenticeship. Conclusion. Pseudophakic children with high myopia and astigmatism can also be successfully fitted with multifocal contact lenses with the aim of increasing visual acuity and stabilizing myopia.

Central Anticholinergic Syndrome Induced by Atropine Eye Drops: A Case Report

Purpose: We present a case of central anticholinergic syndrome following the administration of atropine eye drops.Case summary: A 60-year-old male presented with decreased visual acuity in his left eye and was diagnosed with intraocular lens dislocation. Preoperatively, Isopto atropine<sup>®</sup> eye drops (1 drop at 15-minutes intervals) were used for pupil dilation. Within an hour of the first instillation, the patient exhibited drowsiness, disorientation, agitation, and urinary retention. Laboratory tests and computed tomography of the brain were unremarkable. Considering the recent administration of atropine eye drops, a diagnosis of central anticholinergic syndrome was made. The surgery was postponed and the patient recovered fully after 3 hours of observation. He remained asymptomatic during an additional day of hospitalization.Conclusions: A small dose of atropine eye drops even at a therapeutic dose can induce central anticholinergic syndrome. Therefore, ophthalmologists should be aware of this rare and severe complication.

Sublingual administration of atropine eye drops for treating sialorrhea after stroke: A randomized controlled trial

BackgroundSialorrhea is a common concern in patients with swallowing disorders after stroke. Atropine sulfate blocks the muscarinic receptors in the salivary glands and leads to reduced saliva production. ObjectiveThe present study aimed to assess the safety, efficacy, and tolerability of sublingual administration of atropine eye drops for treating sialorrhea after stroke. DesignThis was a prospective cohort study. SettingThis study was conducted at Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Hubei Province, China. PopulationStroke patients with sialorrhea were analyzed. MethodsOne hundred stroke patients with sialorrhea were randomly assigned to the control group and the test group (n = 50 per group). The control group received routine swallowing rehabilitation training and neuromuscular electrical stimulation. The test group received therapy with 1% atropine eye drops, wherein one drop was administered sublingually 3 times per day. The Sialorrhea Scoring Scale and the incidence of adverse events were used to compare the severity of sialorrhea in the two groups. ResultsThe mean (standard deviation) sialorrhea score improved from 5.12 for the control group with routine rehabilitation training to 3.94 for the test group with atropine eye drop administration (P < 0.01). No significant differences in the incidence of adverse events were observed between the two groups. ConclusionsThe sublingual administration of 1% atropine eye drops three times per day can reduce the degree of sialorrhea to an extent more than that achieved with routine rehabilitation training; thus, this approach is effective, safe, and minimally invasive for treating sialorrhea after stroke.

La atropina en colirio puede prevenir la aparición de miopía en niños y retrasar su progresión

Authors´ conclusions: nightly use of 0.05% atropine eyedrops among children aged 4 to 9 years without myopia resulted in a significantly lower incidence of myopia and lower percentage of participants with fast myopic shift at 2 years. Reviewers´ commentary: this study, of adequate design and quality, concludes that atropine in low concentration helps prevent the onset and rapid progression of myopia in high-risk children, with few side effects. Long-term follow-up is pending to assess adequate follow-up time and possible rebound effect after suspension.

Cardiovascular Effects of Treatment with Atropine 0.01% Eyedrops to prevent the Progression of Childhood Myopia

The effectiveness of atropine eyedrops in preventing myopia progression in children has been confirmed, but cardiovascular effects have never been analysed. The objective of this study was to assess cardiovascular changes after treatment with atropine 0.01% eyedrops in 60 paediatric patients who were treated with atropine eyedrops due to myopic progression. Patients were analysed before treatment and 3 months after starting 1 drop daily. The parameters assessed were cardiovascular constants and electrocardiographic data. The average age was 10.2 years, with a higher women percentage. The average follow-up period was 3.5 months. No patients presented pathological electrocardiographic findings and one patient reported symptoms: palpitations. A statistically significant decrease in heart rate (79 vs. 75 bpm) was reported, but without clinical significance. No changes in blood pressure were observed. In conclusion, chronic therapy with low doses of atropine as a treatment for myopia progression does not result in pathological heart changes.

Efficacy of Combining Highly Aspherical Lenslets Spectacles With 0.01% Atropine Eye Drops in Myopia Control

To explore the difference in myopia control efficacy between spectacle lenses with highly aspherical lenslets (HAL) combined with 0.01% atropine eye drops and spectacle lenses with HAL alone or single vision spectacle lenses (SVL) in children and adolescents. A retrospective cohort study was conducted with a total of 105 myopic children aged 6-15 years. According to the specific myopia correction and control methods of each subject, they were evenly divided into the HAL+0.01% atropine (HAL+AT) group, the HAL group, and the SVL group, with 35 subjects in each group. Relevant data, such as cycloplegic refraction and axial length (AL) at baseline and 12 months after wearing spectacles, were retrieved. One-way analysis of variance, or the Kruskal-Wallis test, was used to analyze the changes in AL and spherical equivalent refraction (SER) after wearing spectacles for 12 months in comparison to those at baseline in the three groups. There was no statistically significant difference in the baseline parameters and duration of wearing spectacles among the three groups (P>0.05). After wearing spectacles for 12 months, the changes in SER were －0.13 (－0.25, 0.00) D, －0.25 (－0.63, －0.25) D, and －0.63 (－1.00, －0.25) D in the HAL+AT group, HAL group, and SVL group, respectively; AL elongation in the three groups was (0.09±0.11) mm, (0.19±0.16) mm, and (0.34±0.16) mm, respectively. The HAL+AT group exhibited slower SER changes (P HAL+AT vs. HAL=0.001, P HAL+AT vs. SVL=0.002) and AL elongation (P HAL+AT vs. HAL=0.009, P HAL+AT vs. SVL=0.001) than those of the HAL and the SVL groups. Compared with those of the SVL group, myopia progression was reduced by 79.4% and AL elongation was slowed down by 73.5% in the HAL+AT group, while in the HAL group, myopia progression and AL elongation were reduced by 60.3% and 44.1%, respectively. According to stratified analysis based on age and myopia progression rate, among younger children aged 6 to 8 years and older children aged 9 to 15 years, the HAL+AT group had a significantly lower proportion of subjects experiencing fast AL elongation (AL>0.36 mm/year) and a significantly higher proportion of subjects experiencing slow AL elongation (AL≤0.18 mm/year) compared to the SVL group (P<0.017). The combination intervention of spectacle lenses with HAL and 0.01% atropine eye drops is effective in controlling myopia progression in children and adolescents, with better myopia control effect achieved using this combination intervention in myopic children of all ages.

Topiramate induced glaucoma: A light on the management

Purpose: To highlight the importance of the use of atropine instead of pilocarpine in topiramate-induced acute angle closure glaucoma. Case report: A 22-year-old female was diagnosed as a case of bilateral topiramate-induced acute angle closure glaucoma. Topiramate was discontinued. She was started on intravenous Mannitol (20 mg) TDS, oral Acetazolamide (250 mg) QID, Brimonidine (0.2%) with Timolol (0.5%) eye drops BD, Prednisolone eye drops (1%) four times and Atropine eye drop (1%) OD. Vision and intraocular pressures were documented twice daily. The patient was symptomatically better, with improvement in visual acuity, normalization of intraocular pressure, and restoration of anterior chamber depth. Conclusion: Baseline ophthalmic evaluation and monitoring throughout the topiramate course should be recommended for early detection and prompt management to maintain optimum visual function.

The Effect of Alternating Monocular Instillation of 0.125% Atropine in Korean Children with Progressive Myopia.

Objectives: To identify the effect of alternating monocular instillation (AMI) of 0.125% atropine in Korean children with progressive myopia. Methods: This retrospective single-center study included 120 children with progressive myopia. A total of 60 children (mean age 9.2 ± 2.0 years) wearing glasses who received AMI of 0.125% atropine for one year were allocated to the treatment group. The remaining 60 children (mean age 9.2 ± 1.9 years) with the same refraction, SE, and axial length (AL) who did not receive any treatments except for wearing glasses were allocated to the control group. Ocular findings and the progression rate were compared between the groups pre- and post-treatment, and adverse events were investigated in the treatment group. Results: The mean spherical equivalent (SE) at baseline was -3.87 ± 1.55 D in the control group and -3.90 ± 1.56 D in the treatment group. Pre-treatment SE, age, and AL were similar between the groups; however, post-treatment SE and AL changes were smaller in the treatment group (-0.36 ± 0.46 D/y, 0.21 ± 0.20 mm/year in the treatment group vs. -1.02 ± 0.57 D/y, 0.51 ± 0.20 mm/year in the control group) (Ps < 0.001). The pre-treatment progression rate diminished in the treatment group compared to the control group after one year (p < 0.001), and the changes in pupil size under mesopic and photopic conditions in the treatment group increased by 0.03 ± 0.05 mm and 0.76 ± 0.90 mm, respectively. Regarding adverse events, a tingling sensation was noted in two patients (3.3%) in the treatment group. Conclusions: Alternating monocular 0.125% atropine eye drop instillation may be effective and suitable for progressive myopia in Korean children.

Evaluation of 0.1% and 1% atropine eyedrops in cats: A comparative study of tolerance, stability, and efficacy.

Investigate the tolerance, stability, and efficacy of topical 0.1% and 1% atropine in cats. Six cats underwent two trials separated by a 2-week washout period. One drop of artificial tears was placed in one randomly selected eye (control), and one drop of either 0.1% atropine (Trial I) or 1% atropine (Trial II) was placed in the other eye. Immediate adverse effects were recorded for severity (0-3) and duration (seconds). Horizontal pupil diameter (HPD), pupillary light reflexes (PLRs), intraocular pressure (IOP), Schirmer tear test-1 (STT-1), and heart rate (HR) were monitored at baseline then 8 h post-administration. PLRs were assessed for a total of 72 h. Stability was assessed weekly for 1 month in room temperature and refrigerated conditions, evaluating solution clarity, pH, and drug concentrations. Adverse effects had a significantly lower severity score and shorter duration with 0.1% versus 1% atropine (severity 1.2 ± 0.4 vs. 2.5 ± 0.5, p = .010; duration 107.5 ± 53.3 vs. 293.3 ± 106.5 s, p = .009). HPD was significantly greater than baseline measurements as early as 40 min for both atropine formulations. Pupils were non-responsive for a significantly shorter duration with 0.1% versus 1% atropine (median 7 h vs. 47.5 h, p = .031). Compared with control eyes, IOP was significantly elevated by 1% atropine (p = .021) but not 0.1% atropine (p = .502). No significant differences were noted in STT-1 and HR measurements. Both solutions were stable in room temperature and refrigerated conditions for 1 month. Diluted 0.1% atropine was stable and better tolerated by cats, offering a potential alternative to feline patients that experience adverse effects from topical 1% atropine.